Department of Urology, U.T. Southwestern Medical Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9110, USA.
Int Urogynecol J. 2022 May;33(5):1125-1143. doi: 10.1007/s00192-021-05042-z. Epub 2022 Jan 4.
Intravesical antimicrobials (IVA) provide a localized modality of treatment for recurrent urinary tract infections (rUTIs). Owing to the sporadic use of these treatments, we conducted a systematic review on the efficacy of IVA in the management of uncomplicated rUTIs.
A systematic review was conducted for all English language articles from inception to April 2021 utilizing the Cochrane and Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards with the following databases: PubMed, OVID Embase, Biomed Central, and Scopus. References were cross-examined for further articles. Risk of bias was assessed in the articles included using the Cochrane and Joanna Briggs Institute tools.
The initial search resulting in 476 titles led to 15 full-text articles. Of the 13 in the final review (2 RCTs), 3 used gentamicin and 10 used hyaluronic acid IVA. These included 764 participants, mostly women, with a mean age range of 27-80 (median: 53.1). There was a reduction in UTI frequency in 12 out of 13 studies, with 10 studies showing a statistically significant decrease. Dosages of 80 mg of gentamicin per instillation and both 40 mg and 800 mg of hyaluronic acid per instillation were found to be effective in reducing the frequency of UTIs in most studies. Eleven participants reported gentamicin-resistant infections after IVA treatment. Despite high levels of bias in selected categories, the 13 studies were designated to be of high quality for inclusion.
The IVAs gentamicin and hyaluronic acid with chondroitin sulphate demonstrated efficacy in the management of uncomplicated rUTIs, mostly in women.
膀胱内抗菌药物（IVA）为复发性尿路感染（rUTI）提供了一种局部治疗方法。由于这些治疗方法的使用较为零星，因此我们对 IVA 治疗单纯性复发性尿路感染的疗效进行了系统评价。
我们按照 Cochrane 和系统评价和荟萃分析报告的首选条目标准，利用 Cochrane 和 Preferred Reporting Items for Systematic Reviews and Meta-Analyses 标准，对所有从开始到 2021 年 4 月的英文文章进行了系统评价，并使用了 PubMed、OVID Embase、Biomed Central 和 Scopus 数据库。为了寻找更多的文章，我们还对参考文献进行了交叉检查。我们使用 Cochrane 和 Joanna Briggs Institute 工具评估了纳入的文章中的偏倚风险。
最初的搜索产生了 476 个标题，导致 15 篇全文文章。在最终的综述中（2 项 RCT），有 13 项研究使用了庆大霉素，10 项研究使用了透明质酸 IVA。这些研究包括 764 名参与者，大多数是女性，平均年龄范围为 27-80 岁（中位数：53.1 岁）。13 项研究中有 12 项研究降低了 UTI 的发生频率，其中 10 项研究显示统计学上显著降低。大多数研究发现，每次灌注 80mg 庆大霉素和每次灌注 40mg 和 800mg 透明质酸都能有效降低 UTI 的发生频率。11 名参与者报告在 IVA 治疗后出现了对庆大霉素耐药的感染。尽管在一些类别中存在高度偏倚，但这 13 项研究仍被认为是高质量的纳入研究。
IVA 中的庆大霉素和透明质酸联合硫酸软骨素在治疗单纯性复发性尿路感染方面是有效的，尤其是在女性中。
